BEYOND TECHNIQUE IN SOLUTION-FOCUSED THERAPY: WORKING WITH EMOTIONS AND THE THERAPEUTIC RELATIONSHIP (Book Review)
- Misty Reynolds
- Dec 12, 2024
- 15 min read
A BOOK REVIEW OF BEYOND TECHNIQUE IN SOLUTION-FOCUSED THERAPY: WORKING WITH EMOTIONS AND THE THERAPEUTIC RELATIONSHIP BY EVE LIPCHIK (by Misty Reynolds)
If you have interest in learning more about the concept and process of providing solution focused therapy to clients, it is my pleasure to recommend Beyond Technique in Solution Focused Therapy: Working with Emotions and the Therapeutic Relationship by Eve Lipchik. This book is filled not only with instruction regarding the concept of solution-focused therapy, but additionally provides detailed examples of individuals presenting for therapy, along with recounted portions of the accompanying question and answer sessions to assist the reader with understanding in more depth the actual process of solution-focused therapy (SFT). I was initially drawn into this book and impressed with its intricate use of dialogue in demonstrating to the reader the actual use and process of this type of therapy. Specifically, Lipchik delves into the use of emotion while providing solution-focused counseling to clients. To my surprise, this book impressed me as it methodically revealed the complicated process of SFT, which led me to conclude that there is a need for highly skilled and trained individuals to provide such an important and unique form of counseling. In this book review, I will discuss Lipchik’s Beyond Technique In Solution-Focused Therapy: Working with Emotions and the Therapeutic Relationship.
In the foreword written by Wendel A. Ray, PhD, the director of the Mental Research Institute and a Professor of Family Therapy, Dr. Ray recalls his first meeting with the author Lipchik back in 1983. Dr. Ray remarks that it would be a surprise if this author remembers each of the many therapists that she has taught over the years, but he definitely remembered vividly their first meeting during an intensive training program at the Brief Family Therapy Center. Dr. Ray recalls that the highlight of the week-long training program was spending an afternoon observing Lipchik work and talking with her. He notes that her “grasp of theory,” “skill as a teacher,” and “remarkable therapeutic ability” were so “impressive” that he was led to begin following Lipchik’s work. Thereafter, Dr. Ray has attended the author’s seminars, conferences and workshops, and has read her contributions to brief family therapy and solution-focused literatures. According to Dr. Ray, he has always walked away “feeling stimulated by the profound implications of her thinking and by her ability to translate the most complex ideas into down-to-earth, clinical applications.” He reveals an opinion that readers of Lipchik’s literature are “presented with a remarkably clear explication of SFT theory and practice,” which Dr. Ray considers “an unfolding of [Lipchik’s] own brand of SFT…described as emotion-centered solution-focused brief therapy.” (pg. ix). Indeed, Dr. Ray describes the author’s major contribution as “the reintroduction of theory into the practice of therapy.” (pg. ix).
In Beyond Technique in Solution-Focused Therapy, author Lipchik prefaces her writing, which she defines as a clinical book, by identifying her intention of demonstrating “a way of thinking about and practicing SFT that negates doubts” about SFT’s “ability to promote permanent change” and to “address clients’ emotional needs.” (pg. xiii). The author breaks the book into two parts with Part I addressing Theory and Practice and Part II consisting of Applications. Lipchik begins Part I with a chapter dedicated to an explanation of the theory of solution-focused therapy with the use of example which is largely relied upon throughout her book. Lipchik is quick to lay out her point: “SFT is more than the trademark techniques it is known for.” (pg. 6). She describes it as “a sophisticated therapeutic model that has been applied to a variety of situations” including adoption, aging, alcohol abuse, child protection services, domestic violence, family-based services, multiple personality disorder, physically impaired clients, residential treatment, sexual abuse, school problems, spirituality, and children. (pg. 6). The author notes that that there may have been some misunderstanding as to the type of therapy offered by SFT as it has been “conceived as a minimalist way of intervening, a pragmatic way of problem solving,” with the idea that the therapist only needs to ask questions, reducing the therapy to “nothing but language.” (pg. 7). She explains that “[l]anguage is not intended to mean only the words people speak,” with the problem being “that emphasis on form over substance usually does not give the desired results.” (pg. 7). According to Lipchik, “[i]f solution-focused therapists assume change occurs through language, and that is understood to mean no more than asking certain questions, disappointing results are probable.” (pg. 9).
Lipchik, through her writing, “proposes a theory and basic assumptions for SFT that refutes the frequent accusation that SFT is formulaic and mechanical. It diverts emphasis from techniques to the therapist-client relationship, so important for successful outcome and to the use of emotions. (pgs. 9-10). She goes on to provide a brief history of SFT, originally conceived as Brief Family Therapy in the late 1970s, with a shift from problem-focused Brief Family Therapy to SFT in 1982. The author explains the nature of language and how it is “seen as part of a person’s individual structure but a mutually dependent action.” (pg. 13). While each person has “a closed neural network that generates its own information…language is an act of mutual adaptation, or consensus about meaning between people and social groups.” (pg. 13).
Toward the end of the first chapter, Lipchik offers eleven solution-focused assumptions which she has developed from her own personal experience with SFT.
1. Every client is unique.
2. Clients have the inherent strength and resources to help themselves.
3. Nothing is all negative.
4. There is no such thing as resistance.
5. You cannot change clients; they can only change themselves.
6. SFT goes slowly.
7. There is no cause and effect.
8. Solutions do not necessarily have anything to do with the problem.
9. Emotions are part of every problem and every solution.
10. Change is constant and inevitable; a small change can lead to bigger changes.
11. One can’t change the past so one should concentrate on the future. (pg. 14-22).
Lipchik notes that “assumptions shape our attitudes toward clients and therefore our relationship with them.” (pg. 22). With regard to clients, the author addresses the therapist-client relationship in chapter 2, describing “how to establish and maintain a relationship” to make the client “feel supported while they adapt or change.” (pg. 25). Lipchik provides research findings in support of the importance of a good therapist-client relationship, with estimates showing the major determinants of outcome of therapy to include 40% as extra-therapeutic factors (internal and external factors brought by clients to therapy); 30% determined by factors related to the relationship of the client to the therapist including caring, acceptance, encouragement; 15% determined by factors particular to the therapeutic model; and 15% placebo effect. (pg. 25). Lipchik describes the solution-focused therapist-client relationship like “a mutual journey to the client’s solution,” with the client making the decisions and taking the lead contributing cooperation, readiness for change, and expectations and the therapist acting as a guide with “questions and answers carefully chosen to help the client clarify his or her direction or change it for one that is more likely to lead to his or her destination.” (pg. 25).
Lipchik identifies as significant the emotional climate of the therapy visit, noting the importance of attempting to establish a relaxed and friendly stance, with suggestions of offering information about the therapist before asking personal information from the client. She also describes the client’s position, stating that clients generally “enter the therapeutic relationship feeling vulnerable and helpless,” hopeless, and often feeling “a lack of control over their life.” (pg. 27). The author notes frequent feelings of inadequacies indicated by the need for change fearing exposure and judgment. In contrast, the therapist should, according to Lipchik, not attempt to “control, influence and advise.” (pg. 27). She instructs that it is best to approach a client from a “not knowing” position. (pg. 29). The therapist should be “more interested in learning what a client has to say than in pursuing, telling, validating, or promoting his or her knowledge or preoccupation.” (pg. 29). Keeping the emotional climate pleasant and relaxed has the advantage of encouraging the client to provide more information to use in therapy with the ultimate goal of the client determining the solution to his or her problem.
Author Lipchik introduces the concept of dual-track thinking, expounding that the therapist should “run two tracks in your mind simultaneously.” (pg. 32). One of these tracks “monitors the client and the other your own reactions.” (pg. 32). According to Lipchik, the client track gathers information including the client’s speech, beliefs, and views while the personal track brings in the therapist’s own thoughts, feelings, emotional reactions, hunches, and knowledge. This concept of dual track thinking is powerful, and Lipchik identifies ways in which a therapist’s personal reactions might influence therapy, and she cautions to maintain distance from personal feelings to clients by calling on the theoretical assumptions, including that every client is unique. Lipchik also stresses the need to place more emphasis on the evolving relationship and the emotional climate than on the use of technique.
Next, the author focuses on the subject of understanding clients, and notes a common question among solution-focused therapists is “how to determine what to respond to and what to ignore when talking with clients.” (pg. 44). Lipchik tells the reader that the “decision about what to respond to and what to ignore concerns the distinction between ‘hearing’ and ‘listening,’” and she explains that while we hear everything the client states, we listen for information based upon our theory and its assumptions. (pg. 44). Lipchik advises that hearing builds a general awareness of the issues, and that it is appropriate to seek clarification as this might lead to a possible solution, providing a shift in direction, which, if the client agrees, may serve as a new focus of our listening. According to Lipchik, “[h]earing and listening are an integral part of language in the sense that they are a recursive process of coordination of linguistic interactions with clients.” (pg. 45). What a client tells a therapist helps to direct a better relationship between the two, and thereby for the therapist to be able to more fully understand the client’s feelings and perspective. The author explains how SFT therapists inquire as to meaning so that the client and therapist may have “more clarity about how the problem is perceived and how clients will know it is solved.” (pg. 46). A great example provided by Lipchik is that of the meaning of the term “divorce,” and how we can understand the definition of the word but the actual meaning will be different for different people due to their past experiences and beliefs. She explains that “divorce” can mean failure, shame, sin, or relief. Lipchik concludes that “there is purpose and strategy to how we choose what to respond to and what to ignore.” (pg. 46).
As for “problem talk” versus “solution talk,” Lipchik offers research findings suggesting that the earlier solution talk occurs, the quicker improvements are made. Two different studies concluded that change occurs sooner, therapy is shorter, and treatment is more likely to be continued and completed with the use of solution talk. However, she notes that it is the client as
opposed to the therapist who determines whether to talk about solutions. The significance of this idea seems to urge Lipchik to note that “it is better to think of the conversations we have with clients as an interactional process (‘languaging’),” rather than just as “problem talk” or “solution talk.” (pg. 48). Ultimately, this idea of “languaging” includes discussions of the problem as well as possible solutions which are “woven into a fabric that will represent the solution to the client. In the end.” (pg. 48). It is Lipchik’s opinion that labeling any parts of the conversation between a therapist and client has little value and can even be distracting. “The artful task of the therapist is to tailor the therapeutic process to individual clients.” (pg. 49). This task, per Lipchik, requires “intuition and judgment that is honed by experience.” (pg. 49). Lipchik indicates the burden is ultimately on the therapist to hear and understand the client.
As for the concept of content versus process, Lipchik explains that content is what clients tell us about their world, but that clients are usually unaware of their processes (or how they act in relation to their situations). Process, she notes, includes not only how clients act to each other but also how they interact with therapists. She explains further that a therapist’s process with clients “is a conversation in which they tell us and show us how they are stuck, and we talk with them about their past, present, and future ideas and experiences about being unstuck.” (pg. 49- 50). Lipchik states that “[t]he goal of SFT is to use language with clients in a way that affects content and process, much like strategic therapists do.” (pg. 49). Before moving on to a discussion of emotions in SFT, Lipchik notes that an emphasis on technique versus hearing and listening is not uncommon but perpetuates a way of doing SFT that is not good therapy.
As for the use of emotions in SFT, the author recounts her emphasis or lack of emphasis on the use of emotions in therapy has changed over the years. Today, she notes that she advises trainees “not to ignore the feelings because they are important resources for solutions, just as
thoughts and behaviors are.” (pg. 62). Lipchik explains that there is no “general consensus” on the definition of feelings, affect, and emotion. She points to affect as “referring to a reflexive reaction, controlled by the autonomous nervous system, whereas feelings are the awareness of what one is sensing.” (pg. 62). “Awareness,” according to Lipchik, “is obviously a cognitive function, and juxtaposing it with feelings calls to mind past academic disputes about whether emotions can occur prior to and independently of, cognitive processes or whether all emotional responses are preceded by some basic cognitive process.” Lipchik states that recent neuroscientific studies have indicated that “cognition and emotion are separate but interacting brain functions mediated by separate but interacting brain systems.” (pg. 63). “Consequently,” per Lipchik, “if emotions are ‘a biological dynamic’ that determines actions they can be understood to involve affect, feelings, cognition, and behavior.” (pg. 63).
The author also discusses emotions versus behavior, noting that solution-focused therapists have traditionally sought behavioral descriptions of goals from their clients for ease of tracking progress, though clients generally talk in terms of feelings instead of behavior. She indicates that it is possible to “cooperate with clients and use their feeling words in conversation without sacrificing the benefit of more concrete signs of progress.” (pg. 64). Lipchik cautions that it “may be in the clients’ best interest to talk with them in their language, even if that is emotion, rather than risk that they do not feel understood.” (pg. 65). The writer further encourages the solution-focused therapist to think about the client’s feelings, being sensitive to their verbal and nonverbal responses. She points out that a client’s “inability to know what they feel may have served a positive function for a long time, a way of protecting themselves from feelings they cannot bear.” (pg. 65). She notes that “a sudden lifting of the veil can be more disturbing than helpful.” (pg. 65). Lipchik again offers samples of question and answer counseling sessions, and reminds that solution-focused therapists must remain guided by the “assumptions that therapists cannot change clients” but instead that clients must “change themselves,” in addition to small change leads to bigger change. (pg. 70). It is apparent from Lipchik’s instruction and guidance that change must be on the part of the client and that this is not always a quick process. With regard to clients’ nonverbal language, Lipchik advises that the therapist, while not a mind reader, should be “as alert as possible to signs of unspoken feelings” and by monitoring “our own thoughts and feelings.” (pg. 73).
Lipchik concludes her discussion of the appropriate consideration of emotion by stating that “[e]motions can facilitate solutions by offering an important way of connecting with and understanding clients.” (pg. 76). She encourages the creation of a secure emotional climate in addition to using one’s own intuition and feelings in helping clients form more awareness of their feelings and hopefully use them in finding solutions. “We cannot live productive lives without emotion, and therefore emotion has to be included in solutions for better living.” (pg. 77).
The next section entails the author’s discussion of the process of clarifying goals, and she is clear that this “goal clarification” is an “ongoing process” as opposed to concrete goals as set out in the initial session. This aids in prevention of depriving the client of choice, which Lipchik indicates is not good SFT. (pg. 78). As for consideration of goals versus solutions, Lipchik states that a client’s solution “will be whatever [they] perceive as making their situation less problematic, or nonproblematic, at a particular time…Solutions are the end product of a process of discovery.” (pg. 79). Solutions have more recently been referred to as “a process about evolving meaning and refer to it as ‘goaling.’” (pg. 79). Lipchik notes that there is often a rush to define goals, spurred on often by managed care companies “that demand concrete evidence that therapists are using their time in a constructive manner.” (pg. 79). Lipchik remarks that the need to hurry and identify a goal can be “detrimental to the emotion climate of the therapist-client relationship.” (pg. 79).
When considering goal setting, Lipchik reminds that “[i]t takes time and patience to help clients understand what they want from therapy.” (pg. 80). She references the assumption that “brief therapy goes slowly,” and recommends maintaining a flexible attitude. (pg. 80). The author states that “clarifying goals” is “a process that begins in the first session and continues until termination,” calling for “constant monitoring of clients to make certain we are on the same track as they are.” (pg. 80). Lipchik suggests the following questions as helpful in the process of clarifying goals:
1. What do you think the problem is (now)?
2. How will you know the problem is solved?
3. How will you know you don’t have to come here anymore? What will the signs be?
4. What will have to be different for that to happen in terms of your behaviors, thoughts, and feelings?
5. What will you notice that is different about others involved in the situation?
6. What is your wildest fantasy about what you want to have happen? (pg. 81).
The importance of a client being clear about his or her goal is only then will they be able to develop a solution. “Every client is unique, and therapists cannot change clients; clients have to change themselves, and only the client can know when that time has come.” (pg. 81). Lipchik further states that “the role of the solution-focused therapist is to facilitate the process of self awareness for clients so that the perturbations will have a greatest probability of becoming fitting solutions for them.” (pg. 81). Additionally, she clarifies that because “emotions are part of language, they should be included in clarifying goals.” (pg. 81). Notably, Lipchik teaches that “[c]larifying as part of ongoing conversation provides more security” since changing their initial goals may be viewed or considered by the client as failing in counseling. As for the client whose goal is ultimately to change someone else’s behavior, the author states that clients must also “understand that therapists can’t change clients; clients have to change themselves.” (pg. 97). She advises being honest and informing that all “we can realistically offer is an exploration of options.” (pg. 98).
In her final two chapters of part I of the book dealing with theory, Lipchik addresses the “team behind the mirror and the consultation break” and the summation message and suggestion. First, Lipchik explains that this team process was originally one whereby observers sat behind a one-way mirror at the Brief Family Therapy Center, acting as detached observers who never met one-on-one or even communicated with the clients. (pg. 99). These observers assisted in therapy by calling in questions to be asked or clarified and assisted the therapist in preparing a summation message to be read to the client at the conclusion. Lipchik offers different benefits for the therapist as well as the client, but notes that most people will not have the opportunity for this counseling style as few practices are able to offer the resources (including multiple therapists and time) to provide for it. The author does reiterate the necessity of the break however, in the solution-focused counseling process, stating that the break should be introduced at the beginning of the session and handled routinely. She notes that clients usually respond well to the break because they feel they are receiving thoughtful care. (pg. 103).
As for the summation message and suggestion, the author explains they are closely related but she treats them separately as their formulation may be based on different information. (pg. 108). In explaining the summation message, which she instructs should be given in conversational tone, Lipchik offers the following as structure of the summation paragraph for the initial session:
1. The stated complaints and/or problem.
2. The historical background to the present situation.
3. The clients’ description of what they want to have happen.
4. Presession progress and strengths.
5. Anything clients say about how they feel emotionally.
As for subsequent sessions, the paragraph should also include the clients’ reports of what has happened since the last session in terms of change; the clients’ reactions to change or no change; and any new information revealed by the clients, including strengths, resources, and feelings. (pg. 110).
At the conclusion of the summation message, Lipchik directs that a suggestion be made by the therapist to the client, remembering that SFT goes slowly, with suggestions tailored by how the client described the situation (content); what did the clients say they wanted; how the clients act about what they are saying (process); and ways that the different information or perspective provided in the summation message can be translated into a suggestion. (pg. 115). Lipchik notes the difficulties in preparing the summation and suggestion, adding that “it is a true synthesis of what our clients are able to offer us and what we can offer them in terms of our professional knowledge and humanity.” (pg. 121). In conclusion, Lipchik urges the reader to note “how all the pieces of the solution-focused process fit together” with “the emotional climate [facilitating] the interview [generating] information for the summary.” (pg. 123). She notes that the “summary repeats that information, adds to it, and makes it experiential by means of a task.” (pg. 123).
Part II of the book is very practical and addresses application of the SFT theory to specific types of counseling including couple therapy, family therapy, work with involuntary clients, long-term cases, and finally, the solution-focused approach to crisis. What is most notable about Part II is
Lipchik’s ability to apply the solution-focused approach to each of these different categories, clarifying the particular issues and various sensitivities of each type of situation. She delivers a substantial amount of practical advice and explanation. I highly recommend this book to those interested in learning more about SFT, as Lipchik demonstrates considerable knowledge and command of the subject. This book, along with our classroom instruction, has “opened my eyes” in a sense to the incredible complexities inherent in solution-focused counseling, as well as the clear benefits to clients in this type of therapy.
Love,
Misty Reynolds
Eve Lipchik, Beyond Technique in Solution-Focused Therapy: Working with Emotions and the Therapeutic Relationship (New York, NY: Guilford Press, 2002). https://a.co/d/0iS1ZMjq
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